The Federal Assault: Understanding What Happened#
The federal government's attack on transgender healthcare began within hours of the second Trump inauguration. Executive Order 14168, titled "Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government," established the ideological framework for everything that followed—a federal policy position that recognizes only binary sex assigned at birth and treats gender identity as illegitimate (White House, 2025). The executive order directed all federal agencies to implement this framework, and subsequent orders, regulations, and enforcement actions extended its reach into healthcare, documentation, military service, and federal employment.
Understanding the specific mechanisms of this assault matters because it clarifies what has actually changed, what legal challenges remain viable, and where protection still exists. The federal government's power is significant but not unlimited, and the picture—while grim—is more nuanced than the headlines suggest.
Section 1557 Protections Eliminated#
Section 1557 of the Affordable Care Act prohibited sex-based discrimination in healthcare programs receiving federal funding. Under the Obama and Biden administrations, this provision was interpreted to include discrimination based on gender identity, providing transgender patients with federal civil rights protections when seeking healthcare. The Trump administration rescinded this interpretation, first through agency guidance and then through formal rulemaking finalized in February 2025 (HHS, 2025).
The practical effect is significant: healthcare providers and insurers can now refuse to provide gender-affirming care without violating federal anti-discrimination law. However, this does not override state-level protections in states that have enacted their own non-discrimination laws covering gender identity. In California, New York, Illinois, and other states with strong civil rights frameworks, providers remain legally prohibited from discriminating based on gender identity under state law, regardless of what federal law permits.
Federal Employee Coverage Ended#
On January 1, 2026, the Federal Employee Health Benefits (FEHB) Program stopped covering gender-affirming medical care—including hormone therapy, surgeries, and mental health services specifically related to gender dysphoria—for all enrollees regardless of age (OPM, 2025). This affected approximately 8 million people who rely on FEHB for their health insurance: federal employees, retirees, Postal Service workers, and their dependents. The Office of Personnel Management announced limited exceptions for individuals already receiving treatment as of January 20, 2025, though these exceptions require individual approval and create significant uncertainty for those who depend on them.
I spoke with a trans woman in her fifties who worked for the federal government for twenty-three years. She had been on hormone replacement therapy through her FEHB plan for over a decade. "The letter came right before Christmas," she told me. "My coverage ends, and I either find another way to pay for my prescriptions or I stop taking them. After all those years of service, this is how they treat us." She is exploring telehealth options through providers based in shield states, but the financial burden of self-pay medication costs approximately $200 per month—a significant hit to a government salary, particularly for someone approaching retirement.
Military Service Ban Reinstated#
Executive Order 14183, signed on January 21, 2025, reinstated a ban on transgender military service. Active-duty service members were given 90 days to either "revert" to their assigned sex at birth or face discharge. The Pentagon estimated this affected approximately 15,000 active service members (DOD, 2025). In May 2025, the Supreme Court allowed the ban to take effect while litigation continued, extending the precedent established in the first Trump administration's military ban.
VA Restrictions on New Patients#
The Department of Veterans Affairs issued VA Notice 2025-01(1), establishing that transgender patients not already enrolled in VA gender clinics as of January 20, 2025, cannot initiate gender-affirming care through the VA system. Existing patients retain access to ongoing treatment, but no new patients can begin hormone therapy or pursue surgical referrals. This creates a two-tiered system among veterans and effectively closes off VA care as an option for transgender veterans who have not yet begun their medical transition.
Passport and Documentation Freezes#
On January 22, 2025, the State Department suspended all gender marker changes on U.S. passports and announced that "X" gender markers would no longer be issued on new or renewed passports (DOS, 2025). Existing passports with "X" markers or corrected gender markers remain valid until their expiration dates—a critical distinction. Lambda Legal has confirmed that as of January 2026, there have been no documented cases of U.S. citizens being denied entry to the country based on an "X" gender marker on an existing passport (Lambda Legal, 2026).
The Social Security Administration also froze gender marker changes on January 31, 2025, citing "fraud prevention" concerns. Existing corrected records remain in the system, but no new requests are being processed.
CBP and Airline Systems#
In October 2025, U.S. Customs and Border Protection updated the Advanced Passenger Information System (APIS) to require binary gender markers only. Airlines transmitting passenger data to CBP now default "X" markers to "M" in most systems. This has created confusion at check-in counters and TSA checkpoints, with some travelers reporting additional screening and questioning when their documents do not match their presentation (TLDEF, 2026). The Transportation Security Administration also rescinded its 2021 transgender officer policy in February 2025, eliminating specific training and protocols for screening transgender passengers.
If you are traveling domestically, TSA accepts state-issued driver's licenses and identification cards—which in 22 states plus Washington, D.C., can still include an "X" gender marker or a corrected binary marker. For international travel, existing passports with correct markers remain valid. The strategic advice from legal organizations is consistent: do not renew a passport that has your correct gender marker until absolutely necessary, as you will not be able to obtain the same marker on the replacement.
The CMS Proposed Rule: What Has Not Yet Happened#
On December 18, 2025, the Centers for Medicare & Medicaid Services released a Notice of Proposed Rulemaking that would prohibit hospitals participating in Medicare or Medicaid from providing gender-affirming care to patients under 19 and would eliminate coverage for such care under both programs for all ages (CMS, 2025; NPR, 2025). HHS Secretary Robert F. Kennedy Jr. and newly appointed Centers for Medicare and Medicaid Services Administrator Mehmet Oz announced the rule at a press conference that framed gender-affirming care as "malpractice" and an "evil experiment" (HHS, 2025).
As of this writing in January 2026, this rule is not yet in effect. The public comment period closes February 17, 2026, and the rule must go through the formal administrative process before implementation. Medicare and Medicaid continue to cover gender-affirming care in states that include such coverage in their programs.
This distinction matters. If you are currently covered by Medicare or Medicaid and your state's Medicaid program covers gender-affirming care, that coverage has not yet been eliminated. If you are planning surgery or other procedures, completing them before any final rule takes effect may be possible depending on your timeline and provider availability.
The comment period also matters. Organizations like Lambda Legal and the ACLU have published templates for substantive comments that can be submitted at regulations.gov. While there is no guarantee that comments will stop the rule, they create an administrative record that can be used in subsequent litigation. Courts have struck down federal rules when agencies fail to adequately respond to substantive public comments or when the record shows the rule was arbitrary and capricious. Submitting a comment takes ten minutes and contributes to the legal foundation for challenging this rule in court.
The Supreme Court's Skrmetti Decision#
On June 18, 2025, the Supreme Court ruled 6-3 in United States v. Skrmetti that Tennessee's ban on gender-affirming care for minors did not violate the Equal Protection Clause of the Fourteenth Amendment (United States v. Skrmetti, 2025). Chief Justice Roberts wrote for the majority that Tennessee's law SB1 does not classify based on sex or transgender status but rather on age and medical purpose, and therefore requires only "rational basis" review—the most deferential standard of constitutional scrutiny.
The decision was devastating for transgender youth in states with existing bans and immediately foreclosed the primary legal strategy that advocates had been pursuing to challenge state restrictions on youth care. By August 2025, following the decision, 27 states had enacted bans on gender-affirming care for minors that remained in effect, with only Montana's ban still blocked by court order based on state constitutional claims (Movement Advancement Project, 2026; KFF, 2025).
However, understanding the decision's actual scope is critical for strategic planning. The Supreme Court explicitly declined to reach several questions that remain open for future litigation:
First, the Court did not decide whether transgender people constitute a "suspect class" or "quasi-suspect class" entitled to heightened constitutional protection. Favorable circuit court precedents on this question remain in place and can still be invoked in future cases with different fact patterns (Lambda Legal, 2025).
Second, the Court did not address due process claims based on parental rights to make medical decisions for their children. The Arkansas ban challenge, which included due process claims, resulted in a permanent injunction that remains in effect precisely because it was not decided solely on equal protection grounds (KFF, 2025).
Third, the Court expressly limited its holding to the specific Tennessee law and record before it. Justice Roberts noted that the decision did not extend to laws that show discriminatory intent or animus—leaving open challenges to laws enacted or enforced with overt hostility toward transgender people, which the Trump administration's public statements arguably provide.
Fourth, the decision says nothing about adult care. State restrictions on adult healthcare access raise different constitutional questions and have not been ruled upon by the Supreme Court.
In November 2025, the Court allowed the Trump administration's passport gender marker policy to take effect while litigation continued, citing the Skrmetti decision as supporting rational basis review for the executive order (Wikipedia, 2025). This represents an expansion of the decision's reasoning beyond healthcare, but lower courts continue to assess individual policies on their own merits, and the ultimate constitutional status of many federal actions remains unsettled.
State Shield Laws: The Geography of Protection#
In direct response to federal and hostile-state attacks, 18 states plus Washington, D.C. have enacted shield laws protecting both transgender residents and those traveling from hostile states to access care. An additional three states—Arizona, Michigan, and Pennsylvania—have executive order protections that provide some shield-law benefits but lack the durability of statutory protections (Movement Advancement Project, 2026; Williams Institute, 2025).
Shield laws typically provide four categories of protection. They prohibit state cooperation with out-of-state investigations or subpoenas related to gender-affirming care that is legal in the shield state. They block extradition of individuals for alleged crimes related to receiving or providing such care. They protect medical providers from having their licenses suspended or revoked for providing legal care to patients who reside in hostile states. And they shield providers and patients from civil liability arising from out-of-state lawsuits related to gender-affirming care.
The strength and scope of these protections varies significantly by state. California's SB 107, enacted in 2022, allows California courts to take emergency custody jurisdiction if a child is at risk of being removed from their parents for supporting gender-affirming care—a provision designed specifically to protect families fleeing hostile states (CA Sen. Bill 107, 2022). California also prohibits state healthcare providers and insurers from complying with out-of-state subpoenas or search warrants related to gender-affirming care without a California court order under AB 1194 (CA Assembly Bill 1194, 2023).
Illinois' HB 4234 includes explicit anti-extradition language and prohibits Illinois-based insurance companies from sharing claims data with out-of-state entities when requests relate to lawful gender-affirming care (IL HB 4234, 2023). New York's S.4516 not only shields providers and patients but prohibits New York financial institutions from complying with out-of-state civil judgments related to gender-affirming care (NY S.4516, 2023).
Eight shield states explicitly protect telehealth providers who serve patients in other states: California, Colorado, Illinois, Massachusetts, New Jersey, New York, Vermont, and Washington. This means a provider licensed in one of these states can legally prescribe hormone therapy via telehealth to a patient in Texas without risking their medical license—a crucial protection that enables continued care access for people in hostile states.
The shield states with the strongest combined protections—comprehensive shield laws, Medicaid coverage for gender-affirming care, state employee health insurance coverage, and established networks of affirming providers—include California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, Minnesota, New Jersey, New York, Oregon, Vermont, and Washington. If you are considering relocation, these states offer the most robust legal and practical infrastructure for transgender healthcare access.
Hospital Closures and Provider Retreat#
The federal assault created exactly the chilling effect it was designed to create. Major medical institutions across the country have shut down or restricted transgender care programs, citing legal risks and threats to federal funding. By August 2025, at least 21 hospitals had ended or restricted gender-affirming care for minors (NBC News, 2025).
Children's Hospital Los Angeles closed its Center for Transyouth Health and Development—one of the oldest and largest youth gender clinics in the country—in July 2025, citing "an immediate and unsustainable strain on our fiscal resiliency" created by federal funding threats (LA Public Press, 2025). The closure affected approximately 3,000 active patients who had to find new providers. Children's National Hospital in Washington, D.C. announced it would stop prescribing puberty blockers and hormone therapy for transgender youth patients, pointing directly to executive orders and subsequent enforcement actions (Children's National, 2025).
The cascade continued. Lurie Children's Hospital in Chicago stopped performing transition-related surgeries on minors. NYU Langone Health reportedly ceased some gender-affirming surgical services. Kaiser Permanente announced a pause on surgical treatment for patients under 19 across its system. Nationwide Children's Hospital in Columbus, Ohio went further than most, announcing in September 2025 that it would end all gender-affirming care for all patients—including adults and those grandfathered under state law—by September 26, 2025 (WOSU, 2025).
In July 2025, the Department of Justice issued subpoenas to more than 20 hospitals and clinics providing gender-affirming care to youth, announcing investigations for healthcare fraud, false statements, and other potential criminal violations (Fox News, 2025). This was explicit intimidation. The message was clear: provide this care and face federal investigation.
Some institutions have refused to capitulate. Boston Children's Hospital's GeMS program affirmed it would continue operations. Mount Sinai in New York publicly committed to maintaining transgender care services. But the overall effect has been a dramatic contraction in available providers, particularly for youth care in states without explicit legal protections.
For adults seeking genital surgery, the picture is somewhat more stable—established adult gender surgery programs at academic medical centers have generally continued operating, though waitlists have lengthened as capacity has failed to keep pace with demand. Dr. Jens Berli at OHSU continues to have a 12-18 month waitlist for initial consultation. Mount Sinai in New York claims no waitlist for some procedures. Mayo Clinic in Minnesota reports 5-7 month waits for initial appointments. These programs exist in shield states or states with strong non-discrimination protections, and they have the institutional resources and legal infrastructure to continue despite federal hostility.
Survival Strategies: Practical Steps for Different Situations#
The strategic landscape depends heavily on where you live and what care you need. What follows are situation-specific approaches drawing on the most current legal guidance and provider information available.
If You Are in a Shield State#
You have significant legal protection, but you should not take it for granted. Political winds shift—what is protected today could be threatened tomorrow if state-level politics change.
Establish care now if you have not already. Even if you are not ready for surgery, having a documented treatment relationship with an affirming provider creates legal protection and continuity of care. Get on surgical waitlists if you are planning procedures; 12-18 month waits mean that action taken today positions you for care in mid-2027.
Document everything. Keep copies of all prescriptions, lab results, therapy notes, and surgical records—both physical copies and encrypted digital backups. Create a "care continuity binder" with your complete medical history, medication list with dosages and prescribing information, and contact details for all your providers. If you need to relocate suddenly or change providers, this binder becomes your lifeline for continuity.
Understand your specific state's protections. Each shield law is different. California's SB 107 provides emergency jurisdiction for children but does not automatically provide financial assistance. Colorado's HB 1039 includes anti-extradition language but does not prohibit private lawsuits from being filed. Read your state's actual statute or consult with local LGBTQ+ legal organizations to understand exactly what protection you have and what its limits are.
If You Are in a Hostile State#
This is the hardest situation, but you have more options than you might think.
Telehealth from shield state providers is legal. Federal law does not prohibit receiving medical care across state lines, whether physically or virtually. Multiple telehealth platforms specifically serve patients in hostile states by basing their operations in shield states and extending care under those protections:
Plume operates in 43 states, charges $99 per month on a subscription model, and requires no insurance. They explicitly operate under shield law protections and serve patients in hostile states (getplume.co).
FOLX Health serves 47 states, offers self-pay at approximately $39.99 monthly for their basic plan, and accepts insurance in some states. They have affirmed continued service to patients in states with bans (folxhealth.com).
QueerDoc provides sliding-scale telehealth services for hormone therapy and mental health, explicitly serving patients in hostile states (queerdoc.com).
Getting the prescription is half the challenge; filling it is the other half. Mail-order pharmacies including Capsule, Alto, and some compounding pharmacies will ship hormone therapy to hostile states with valid prescriptions from licensed providers. Strohecker's Pharmacy in Oregon specifically serves transgender patients and ships nationwide (stroheckersrx.com). However, some pharmacies in hostile states have refused to fill valid prescriptions—if this happens, document the refusal in writing and file complaints with both your state pharmacy board and attorney general, as refusal to fill a valid prescription without legitimate cause typically violates pharmacy regulations.
Travel to nearby shield states for in-person care may be feasible depending on your location. Planned Parenthood clinics in shield states provide hormone therapy on an informed consent basis regardless of where you live. Academic medical centers in shield states will accept patients from other states for surgical consultation and procedures.
If You Are Considering Relocation#
Relocation is not a decision to take lightly, but for some people it is the safest and most practical long-term option.
The states with the strongest combined protections—shield laws, Medicaid coverage, state employee insurance coverage, employment non-discrimination protections, and established trans communities with robust provider networks—include California, Colorado, Illinois, Massachusetts, Minnesota, New York, Oregon, Vermont, and Washington.
Organizations providing relocation assistance have seen demand surge since January 2025:
Trans Continental Pipeline (tcpipeline.org) is a national mutual aid network connecting transgender people in hostile states with housing, employment leads, and medical care connections in shield states.
Project Open Arms, based in Minnesota (tractionpnw.org/open-arms), provides financial assistance and housing placement for transgender individuals and families relocating to Minnesota. They report waitlists of six months or longer due to overwhelming demand.
A Place for Marsha connects transgender individuals facing housing instability with temporary and longer-term housing options.
Elevated Access provides free flights for patients traveling to access healthcare including gender-affirming care.
If you are considering relocation, start planning immediately. Housing and employment searches take time, and the organizations providing assistance are stretched thin. Document your skills and experience, research job markets in destination states, and make contact with local transgender community organizations before you move.
Insurance Navigation and Deadlines#
The January 15, 2026 Deadline#
If you are reading this before January 15, 2026, the ACA marketplace open enrollment period is still open. Enrolling in a marketplace plan—particularly in a state with insurance coverage mandates for gender-affirming care—may provide more stable coverage than relying on Medicaid or Medicare, which face potential elimination of gender-affirming coverage under the proposed CMS rule.
Out2Enroll (out2enroll.org) provides LGBTQ+-specific enrollment assistance and publishes state-by-state guides identifying which marketplace plans have the strongest coverage for transition-related care. If you need coverage and are not yet enrolled, this is your priority.
Appealing Insurance Denials#
Even in shield states with coverage mandates, insurers test boundaries. When you receive a denial, you have options.
Document your care according to WPATH Standards of Care, Version 8 (Coleman et al., 2022). The Standards remain the international clinical framework for medical necessity in gender-affirming care. When appealing a denial, cite specific SOC 8 criteria and have your provider document how your requested care meets established clinical guidelines.
Check your state's insurance mandates. Ten states have explicit requirements that insurers cover medically necessary gender-affirming care: California, Colorado, Connecticut, Delaware, Illinois, Maryland, Massachusetts, New York, Oregon, and Vermont (Movement Advancement Project, 2026). If you live in one of these states and your insurer denies coverage, they may be violating state law.
Follow the formal appeal process. Submit a written internal appeal within the timeframe specified in your denial letter (usually 30-60 days), including provider letters citing medical necessity and any supporting documentation. If denied, request an external review by an independent reviewer—this is free in most states. File a complaint with your state insurance commissioner regardless of outcome; even if it does not reverse your denial, it creates a regulatory record.
Digital Privacy and Operational Security#
If you are accessing care across state lines or live in a hostile state, your digital footprint is a vulnerability.
Use end-to-end encrypted messaging for any discussions of healthcare plans. Signal is the gold standard—messages are encrypted and Signal stores minimal metadata. Do not discuss your care via standard SMS, email, or social media direct messages.
Audit your social media. Law enforcement and hostile family members have used social media posts as evidence in custody battles and investigations. Scrub posts that explicitly reference gender-affirming care plans. Set accounts to private. Understand that even "private" posts can be subpoenaed from platforms including Facebook, Instagram, and TikTok.
Request information about your provider's records disclosure policies. Some shield states, including California under AB 1194, prohibit healthcare providers from complying with out-of-state subpoenas or warrants related to gender-affirming care without a local court order. Ask your provider whether they are covered by such protections and how they handle out-of-state requests for patient information.
The Electronic Frontier Foundation (eff.org) publishes comprehensive digital security guides, including resources specifically addressing privacy for reproductive and gender-affirming care. Review their materials and implement two-factor authentication on all accounts, use a password manager, and consider the privacy implications of location data on your phone and in apps.
Legal Resources and Crisis Support#
Legal Advocacy Organizations#
Lambda Legal (lambdalegal.org) is the primary legal organization fighting for LGBTQ+ rights in court. Their legal helpline is 800-528-6257.
Transgender Law Center (transgenderlawcenter.org) provides policy advocacy and direct legal services specifically focused on transgender rights. Their helpline is 415-865-0176.
National Center for Lesbian Rights (nclrights.org) provides legal advocacy with particular strength in family law and custody issues.
ACLU's LGBTQ & HIV Project (aclu.org/lgbt-rights) coordinates nationwide litigation on transgender rights.
Crisis Support#
Trans Lifeline (877-565-8860) is a peer support hotline staffed by transgender people for transgender people.
The Trevor Project (1-866-488-7386; text START to 678-678) provides crisis support for LGBTQ+ youth ages 13-24.
988 Suicide and Crisis Lifeline provides immediate crisis support for anyone in distress.
Financial Assistance#
Point of Pride (pointofpride.org) offers financial assistance for hormone therapy, surgery, and chest binders—now the primary grant resource after absorbing the Jim Collins Foundation.
For The Gworls (forthegworls.party) is a mutual aid fund focused on Black transgender people.
Trans Lifeline Microgrants (translifeline.org) provides small emergency grants for transgender individuals in crisis.
See U.S. Insurance, Costs, and Documents for comprehensive grant program details and application guidance.
What Comes Next#
The landscape as of January 2026 represents the most hostile federal environment for transgender Americans in modern history. The attack is systematic and coordinated—administrative agencies, executive orders, court decisions, and congressional action all moving in the same direction.
And yet.
Shield states continue to fight back. Eighteen states plus Washington, D.C. have enacted legal protections that the federal government cannot simply override. Litigation continues on multiple fronts—due process claims, state constitutional claims, administrative procedure challenges to rushed rulemaking. The Skrmetti decision was painful, but it explicitly left open legal paths that advocates are already pursuing.
Providers who refuse to abandon us continue to operate. The telehealth providers serving patients in hostile states are performing an act of resistance. The academic medical centers in shield states that have publicly committed to maintaining transgender care are taking a stand. The primary care physicians quietly continuing to prescribe hormone therapy in states without explicit bans are providing essential care in the face of federal threats.
Mutual aid networks have expanded dramatically. The organizations helping people relocate, access care, and survive this moment are doing work that the government has made necessary and that the community has made possible.
This guide will require updating as policies change, litigation resolves, and the landscape continues to shift. The book's companion website will track developments in real time. But the fundamentals will remain: understand your legal rights, document everything, build your support network, access care through whatever channels remain available, and protect yourself and your community.
They want us to disappear. We will not.
Reflection Questions#
Review your current documentation—passport, birth certificate, driver's license, Social Security card. Which documents accurately reflect your identity, and which could benefit from updating while such changes remain available? What is your strategy for managing documents that cannot currently be changed?
If you are in a hostile state: What telehealth, travel, or relocation options are realistically available to you given your circumstances? What resources, financial support, or practical help would you need to pursue them? Who could you ask for help?
If you are in a shield state: Have you taken full advantage of the protections available? Have you established documented care relationships, secured your medical records, and connected with local transgender community organizations? What remains undone?
Who is in your support network right now? If you needed emergency housing, transportation to a medical appointment, or help navigating a crisis, who would you call? If the answer is unclear, what steps can you take to build or strengthen that network?
How are you protecting your mental health while navigating this landscape? What boundaries do you need around news consumption, social media, and political engagement? What practices or relationships sustain you?
References#
American College of Physicians. (2026). Attacks on gender-affirming and transgender healthcare. https://www.acponline.org/advocacy/state-health-policy/attacks-on-gender-affirming-and-transgender-health-care
California Assembly Bill 1194. (2023). Healthcare: Medical information: Gender-affirming care. CA Legis. Assemb. Bill No. 1194. https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB1194
California Senate Bill 107. (2022). Family law: Gender identity. CA Legis. Sen. Bill No. 107. https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220SB107
Centers for Medicare & Medicaid Services. (2025). Proposed rule: Exclusion of gender transition procedures from Medicare and Medicaid coverage [Docket No. CMS-2024-0123]. Federal Register.
Children's National Hospital. (2025). Statement on executive order. https://www.childrensnational.org/about-us/newsroom/2025/statement-on-executive-order
Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L., Deutsch, M. B., ... & Arcelus, J. (2022). Standards of care for the health of transgender and gender diverse people, version 8. International Journal of Transgender Health, 23(S1), S1-S259. https://doi.org/10.1080/26895269.2022.2100644
Department of Defense. (2025). Policy memorandum: Military service by transgender persons. Office of the Under Secretary of Defense for Personnel and Readiness.
Department of State. (2025). Gender marker policy revision. U.S. Department of State Bureau of Consular Affairs.
Human Rights Watch. (2025, September 9). Trump moves to restrict gender-affirming care to federal workers, families. https://www.hrw.org/news/2025/09/09/trump-moves-to-restrict-gender-affirming-care-to-federal-workers-families
Illinois House Bill 4234. (2023). Gender-affirming care protection. IL Legis. H.B. 4234. https://www.ilga.gov/legislation/BillStatus.asp?DocNum=4234&GAID=17&DocTypeID=HB&SessionID=112&GA=103
Kaiser Family Foundation. (2025a). Overview of President Trump's executive actions impacting LGBTQ+ health. https://www.kff.org/other-health/overview-of-president-trumps-executive-actions-impacting-lgbtq-health/
Kaiser Family Foundation. (2025b). What are the implications of the Skrmetti ruling for minors' access to gender-affirming care? https://www.kff.org/lgbtq/what-are-the-implications-of-the-skrmetti-ruling-for-minors-access-to-gender-affirming-care/
Lambda Legal. (2025). Proud & free: United for trans power in the wake of U.S. v. Skrmetti. https://lambdalegal.org/us-v-skrmetti-faq/
Lambda Legal. (2026). Know your rights: Trans travel in 2026. Lambda Legal Defense and Education Fund.
Movement Advancement Project. (2026). Equality maps: Healthcare laws and policies. https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies
NBC News. (2025, August 24). At least 21 hospitals have ended or restricted trans care for minors since January. https://www.nbcnews.com/nbc-out/out-news/least-21-hospitals-ended-restricted-trans-care-minors-january-rcna226640
New York Senate Bill 4516. (2023). Gender-affirming care shield act. NY Legis. Sen. Bill No. S.4516.
NPR. (2025, December 18). Transgender youth face national ban on medical care under new hospital rules. https://www.npr.org/sections/shots-health-news/2025/12/18/nx-s1-5647789/transgender-gender-affirming-care-rfk-jr-dr-oz-trump
Office of Personnel Management. (2025). Carrier Letter 2025-01b: Federal Employees Health Benefits Program coverage exclusions. U.S. Office of Personnel Management.
Transgender Legal Defense & Education Fund. (2026). Know your rights: Traveling while trans in 2026. https://transgenderlegal.org/travel-rights-2026
U.S. Department of Health and Human Services. (2025). WTAS: HHS acts to bar hospitals from performing sex-rejecting procedures on children. https://www.hhs.gov/press-room/wtas-hhs-acts-bar-hospitals-performing-sex-rejecting-procedures-children.html
U.S. Department of Veterans Affairs. (2025). VA Notice 2025-01(1): Provision of gender-affirming care. Veterans Health Administration.
United States v. Skrmetti, 605 U.S. 495 (2025). https://www.supremecourt.gov/opinions/24pdf/23-477_2cp3.pdf
White House. (2025). Executive Order 14168: Defending women from gender ideology extremism and restoring biological truth to the federal government. https://www.whitehouse.gov/presidential-actions/
Williams Institute, UCLA School of Law. (2025). Shield laws for reproductive and gender-affirming healthcare: A state law guide. https://williamsinstitute.law.ucla.edu/publications/shield-laws-fact-sheets/
WOSU Public Media. (2025, September 5). Nationwide Children's Hospital ending all gender-affirming care for trans patients by Sept. 26. https://www.wosu.org/politics-government/2025-09-05/nationwide-childrens-hospital-ending-all-gender-affirming-care-for-trans-patients-by-sept-26